Medical Staff Specialist
Perform all credentialing functions, including intake, primary source verification, documentation, and tracking of credentialing requests, ensure compliance as defined by Joint Commission, CMS and state laws. Provides marketing support and completes credentialing and re-credentialing applications for contracted health plans for hospital facilities to maintain revenue stream. Job Requirement
Equivalent to graduation from high school and three (3) years of Medical Staff and/or Managed Care credentialing experience or related health care experience.
Additional and/or Preferred Position Requirements
PREFERENCE WILL BE GIVEN TO APPLICANTS WHO DOCUMENT THE FOLLOWING:
- Three (3) years recent (within the last three (3) years) experience tracking credentialing; requests;
- Proven experience with compliance as defined by Joint Commission, CMS, and state laws
- Five (5) years recent (within the last five (5) years) credentialing experience in a similar facility.
Knowledge, Skills, Abilities, and Physical Requirements
Office administrative and secretarial practices and procedures; UMC programs, services and organizational structure; UMC policies and procedures as they apply to Primary and Quick Care Units; managed care terminology; credentialing requirements for physicians and PPOs; marketing principles and practices; Federal, state and county laws and regulations related to the health care agency; basic data sampling and statistical analysis techniques; computer applications related to duties; department and hospital safety practices and procedures; infection control policies and procedures; handling, storage, use and disposal of hazardous materials; department and hospital emergency response policies and procedures.Skill in:
Providing varied, responsible and confidential secretarial and office administrative assistance; using tact, discretion, initiative and independent judgement within established guidelines; researching, compiling and summarizing a variety of materials; composing correspondence independently or from brief instructions; organizing work, setting priorities, meeting critical guidelines; coordinating supervisor’s activities and schedules; maintaining confidentiality of sensitive information; problem solving and conflict resolution; addressing and handling matters independently within authorized scope of responsibility; carrying assigned project(s) through, from data gathering to completion; using initiative and independent judgement within general policy guidelines; use of computer software/applications related to duties; maintaining accurate records and files; preparing clear and concise reports, correspondence and other written materials; contributing effectively to the accomplishment of team or work unit goals, objectives and activities; communicating effectively with a wide variety of people from diverse socio-economic and ethnic backgrounds; establishing and maintaining effective working relationships with all personnel contacted in the course of duties; efficient, effective and safe use of equipment.
Physical Requirements and Working Conditions:
Mobility to work in a typical office setting and use standard office equipment, stamina to remain seated for extended periods of time, vision to read printed materials and a VDT screen, and hearing and speech to communicate effectively in person and over the telephone. Strength and agility to exert up to 10 pounds of force occasionally and/or an eligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this classification.